NICE and Society: Health Technology Appraisal and the Cultivation of Social Relations
University of Sheffield, United Kingdom
The paper presents a conceptual sociological examination of the UK National Institute for Health and Care Excellence’s (NICE) approach to health technology appraisals, which inform its recommendations for the allocation of National Health Service resources in the UK. The paper draws on NICE’s documents and on a 2005-2008 interdisciplinary debate about the ethics of NICE’s activities. It is highlighted that, through the comparisons central to its approach, NICE arranges a competition in the production of health between different treatments used on their respective particular patient groups. In fostering a competition for differentiation in which patients are involved alongside their respective health technologies, NICE’s approach resembles objectives for shaping social relationships often attributed to neoliberal politics. Yet closer scrutiny reveals that NICE’s creation of positions for, and relations between, patients is simultaneously more problematic. Patients are inscribed in the position of creatures - rather than agents - of competition. In turn, a comparison between NICE’s work and Max Weber's and Georg Simmel's sociological conceptions of the social relationship offers a critical perspective on the quality of the social relations NICE’s approach supports in more general terms.
Re-thinking Egg Donation in Europe: Expanding Practice, Extending Boundaries
1Loughborough University, United Kingdom; 2De Montfort University, United Kingdom; 3Consejo Superior de Investigaciones Cientificas, Spain; 4Ghent University, Belgium
The expansion of the use of donor eggs in fertility treatment has been exponential. Whilst the majority of egg donation historically took place in the US, donor eggs are used in over 56, 000 cycles of fertility treatment per year in Europe and a number of European egg donation ‘hubs’ have emerged, for example in Spain and Cyprus. Growth in the use of donor eggs in part reflects a changing profile amongst users of assisted reproductive technologies, including growing numbers of older women, male same sex couples, and those at risk from genetic conditions. An increasing number of egg donor ‘intermediaries’ such as egg banks and agencies have also emerged in the European context, reflecting a general shift towards an increasingly commercialised landscape around fertility treatment provision. Despite these changes, few studies have specifically considered their implications.
Drawing on an ESRC-funded study on the economic, political and moral configuration of egg donation in the UK, Spain and Belgium, we suggest that changes in the ways egg donation is provided in the European context are worthy of increased attention. Data from policy mapping and interviews with policy stakeholders and professionals illustrate significant shifts in professional and commercial practice. These changes are reshaping the intersubjective, political and social boundaries involved in egg donation in novel and complex ways. We suggest that the expansion and diversification of its use has implications for the policy and regulation of egg donation the European context.
Selective Technology Adoption in Diabetes Embodiment Processes
University of Bologna, Italy
This research investigated the increasing diffusion of mHealth devices, such as insulin pumps and sensors for glycaemic control, in diabetes management in one Italian Region. To assess their opinions and experiences with the choice and use of mHealth devices, this 2018 study included 50 people with diabetes (in-depth interviews) and 20 diabetologists (semi-structured interviews), engaged through local patients and professional associations and by snowball technique.
The results were interpreted using the STS, phenomenological, and socio-material perspectives, which suggest that mHealth technologies are more than technical products. Indeed, they have a sociocultural foundation and contribute to an affective atmosphere, as such wearables represent an intimate daily encounter between humans and non-humans.
The findings indicate that, despite recommendations from their diabetologists, people with diabetes tended to adopt a selective use of mHealth devices. The participants most often chose to wear or not wear these wearables for two reasons, always considered together: their capacity to keep their chronic condition under control within a pre-set range and their feelings and/or perceptions about each device.
One explanation may be that, as they must be worn continuously in both public and private, wearing these devices might be a barrier to patients’ sociality. Therefore, some patients used both technologies, while most used only one of them. Then, the results reveal that, going beyond the rhetorical presumptions of general satisfaction and management improvement, issues such as perceptions, meaning, atmosphere, and experiences, emerging in the encounter between people with diabetes and each technology, affect their possible adoption or rejection and the continuity of their usage over time.
‘Normal Monthly Period’: A Sociological inquiry into the Medicalisation of Menstruation in Odisha, India
INDIAN INSTITUTE OF TECHNOLOGY, DELHI, India
‘Contemporary biomedicine has come to foster a notion of health as a personal social-ethical imperative.’ (Rose 2007, cited Lamb 2013, p.43) This explains the increasing emphasis and stress on personal responsibility for one’s own health and its regular maintenance. The concern for menstrual health goes beyond just one’s own wellbeing because of the impact it has on others. Menstruation in India is regarded as the hallmark of healthy womanhood. A signal of continued fertility, regular menstruation often becomes an inevitable prerequisite for good health, desirability and completeness in a woman. Menstrual rituals often make menstrual aberrations visible thereby making the existence of the non-menstruating woman stigmatised; with her being constructed as unwell, abnormal and incomplete. Delayed menarche or irregular menstruation often leads to blind reliance on over the counter medication or incessant visits to clinics. The paper is an ethnographic presentation of the medicalisation of menstruation in Odisha. The focus here is on the ways medical help is increasingly being sought for menstrual aberrations at different ages. The paper nuances the understanding of normalcy, health and ill-health through the lived experiences of women on menstrual aberration, fake menstruation and healthy bleeding. The paper also brings into focus the labelling of the menstruating woman as ‘potentially crazy’ (Figert, 1995), unreliable and moody thereby making menstruation and its related behaviour a subject of public scrutiny and medical study. From voluntarily seeking medical guidance to being told to seek medical help, the paper brings forward narratives of women and their medicalised menstrual identity.